Transvaginal intra-amniotic injection of methotrexate in early ectopic pregnancy. Advantages over the laparoscopic approach.

Methotrexate (MTX, 100 mg) was administered to 36 patients with early ectopic pregnancy locally, either under laparoscopic control into the distended fallopian tube (group A, n = 16), or transvaginally into the gestational sac directly, under ultrasound guidance (group B, n = 20). In cases with persistent beta-hCG levels (n = 7), an additional 50 mg of MTX solution was instilled into the affected tube, following transuterine tubal catheterization. Comparing the two different routes of MTX administration, it was shown that the resolution time (beta-hCG < 20 mIU/ml) in group B was significantly shorter (2.4 +/- 1.1 weeks vs. 4.1 +/- 1.9 weeks in group A, P < 0.05), with a better success rate (100% and 88%, respectively). Serum MTX levels were found within a low range and no systemic side effects were noticed. In conclusion, direct intraovular MTX injection under ultrasound guidance proved superior to the laparoscopically-controlled 'blind' intratubal injection. A relatively high dose of MTX (100 mg) seems justified in order to shorten the resolution period, especially in cases with high initial beta-hCG levels and/or fetal heart motion present.